JPS59500949A - surgical stapler with flexible shaft - Google Patents

Abstract

(57) [Summary] This bulletin contains application data before electronic filing, so abstract data is not recorded.

Description

[Detailed description of the invention] Surgical stapler with flexible shaft Background of the invention The present invention relates to surgical staplers and other surgical fastener application devices, and In detail, the shaft has a longitudinally flexible middle section and a stapling function. The present invention relates to a device of this type having an arm part and an actuator part.

(For simplicity, a surgical stapler will be described hereinafter, but the scope of the present invention is It should be understood that this applies to any type of surgical fastener application device. ) The stapling function is performed at a position relatively far from the position where the operator holds and operates the stapling function. Several types of staplers are known. Give an example of such a stapler and U.S. Patent No. 3. /191I-, No. 3, 3, 3 (Green et al.). Illustrated surgical linear closure stapler and U.S. Pat. No. 4.301I-, :1 There is a surgical circular anastomosis stapler exemplified in No. 3 (Conta et al.).

Typically, in devices of the type exemplified by these patents, stapling The tissues to be removed are the anvil assembly and staple holding assembly located at the distal end of the device caught between. This pinched tissue is removed by passing the end of the staple into the tissue. Attach all seven or more staples so that the ends bend upon contact with the anvil assembly. The stapling is performed by driving from the staple holding assembly. make utensils The force required to move the instrument is applied by the operator of the instrument to or from the proximal end of the instrument. Added to seven or more actuator elements located near the ends. the distal part of the instrument and The proximal sections are connected by a longitudinal connecting shaft structure; Actuation forces and movements are transmitted along the structure to remote operating elements. relatively wide range This type of configuration, with a distant part and a near part, is a stapler. the relative inaccessibility of the tissue to be stapled; Used for any number of reasons, such as the need to .

In some applications of devices of the type described above, the distal and proximal parts of the device at least one longitudinal shaft structure coupling the parts is longitudinally flexible; It is desirable to have a portion. This allows you to place the device on specific body structures. This makes it easier to reach remote or relatively inaccessible stapling points. or staples at various angles relative to the instrument operator. It can be present at the kissing point.

However, with this type of instrument configuration, the actuation forces and motions vary widely. must be transmitted through a flexible structure capable of exhibiting a constant rate. this This significantly complicates the design of the device. A variety of actuation forces and movements In addition to transmitting the rate, the structure is generally substantially straight. Friction losses that are considerably greater than those present in relatively straight instruments without any force These forces must be transmitted without loss. Controlling the tendency for eyelashes to straighten and In both cases, control of friction loss is more effective for flexible instruments than for relatively rigid instruments. J: It is also very difficult.

In view of the above points, it is an object of the present invention to combine the distal stapling element with the proximal actuator. To provide an improved external stapler having a flexible shaft structure between the elements. It is.

Summary of the invention This and other objects of the present invention provide that the principles of the present invention allow for curved deformation. during transmission between the universal actuator assembly and the remote stapling assembly; A surgical stapling device is provided with a flexible shaft assembly that maintains its curvature. This is achieved by providing. This shaft assembly transmits longitudinal compressive forces A flexible compression member is provided along the length of the assembly to allow the assembly to bend. When bent, it generates a resultant force perpendicular to the longitudinal axis of the flexible/yaft. Also , - The /yaft assembly has a longitudinally flexible tensioner for transmitting the entire longitudinal tension. A tension member is provided, and this tension increases the readability/yaft assembly when the assembly is bent. perpendicular to the longitudinal axis of the compressor when the tension and resultant force are equal. Therefore, a resultant force that is essentially equal in magnitude and opposite in direction to the resulting resultant force is generated. live. Additionally, the shaft assembly has a compression member and a tension member longitudinally relative to each other. The target is moved by a target, equipped with a device to transmit the resultant force between these parts. There is. produced by a compression member and a tension member through a device for transmitting the resultant force. By matching only one bond of the resultant forces, the entire assembly is essentially in equilibrium in the direction perpendicular to the axis of the direction.

This allows the shaft assembly to return to its straight state during the transmission of longitudinal forces. greatly reduce or even essentially eliminate the tendency to

Further features of the invention, its nature, and various advantages may be further understood from the accompanying drawings and the invention. will become clear from the detailed description below.

Brief description of the drawing Fig. 1 is a perspective view of a surgical stapler constructed according to the present invention; Fig. 2 is an anobyl assembly. FIG. A longitudinal cross-sectional view of the actuator portion of the device showing the device: Figure 3 is shown in Figure Ω. A partial longitudinal sectional view of the part of the device of FIG. are connected to each other along the left side in FIG. 2 and the right side in FIG. ) shows the same state of the device); Figure 9 shows the state in which the stapler/j-I is driven. Figure S is similar to Figure 2 showing the actuator section of the device in Figure 9. FIG. 6 is a diagram similar to FIG. 3 showing the elements of the device in a state corresponding to that of the machine; Figures 1-S show the tissue after it has been stapled and cut by the device. An enlarged longitudinal sectional view of the part of the device shown in the figure; Figures 7 to 74 are formed into a cylindrical shape. A disc-shaped segment with a raised protrusion provides flexibility to the shaft assembly. FIG. 7 is a view showing the first embodiment of the present invention, and FIG. 7 shows the shaft in an undeformed state. Longitudinal cross-sectional views of the shaft assembly: Figure 8 shows various configurations of the flexible shaft assembly. Cross-sectional view along line gg in FIG. 7 showing the radial organization of the components: FIG. Figures 1 to 1 are perspective views showing the shaft assembly at various stages of subassembly; Figure 7.2 shows the motion of adjacent segments when the shaft assembly is deformed into a curve. Schematic diagram; Figure 73 and Figure 1 are for the straight and curved states, respectively. 1 to 77 are longitudinal sectional views showing the shaft assembly in the shaft assembly. The flexible toe assembly has a flat rear surface and a front surface having two beveled portions. Figure 1S is a diagram of another embodiment of the invention provided by segments; Perspective view of the shaft assembly partially disassembled: Figure 1 shows the shaft assembly in its undeformed state. Showing the shaft assembly and deformation of the shaft above and below the midplane of the instrument FIG. 77 is a longitudinal sectional view showing the various components of the shaft assembly in a virtual state. Cross-sectional view along line/ku 77 in Figure 1 showing the organization in the radial direction of the element: Figures 1g to 20 have a flat rear surface and a flat and beveled part. The shaft assembly is made flexible by the segments having a front surface. Figure 1g shows a partially disassembled shaft assembly; Three-dimensional perspective view; Figure 79 shows the shaft assembly in the undeformed state and shows the intermediate plane of the instrument. A longitudinal cross-sectional view showing the deformation of this shaft in a virtual state above the plane; Figure 20 are lines in FIG. 79 showing the radial organization of the various components of the shaft assembly. ,! A cross-sectional view along θ~, , 20: and Fig. 2 shows the flexible shaft assembly. FIG. 3 is a schematic diagram showing the spatial relationship between a tension member and a compression member.

Hereinafter, the present invention will be explained in more detail with reference to the accompanying drawings.

Although the present invention can be applied to other types of surgical hoogies as previously described, , may not be fully understood from the description applied to a particular surgical circular anastomosis stapler embodiment. Good morning.

One embodiment of the present invention is an external 7-F circular anastomosis stapler 1 shown generally in FIG. It is 0. The stapler 10 typically has a circular shape surrounding the lumen or passageway of the organ. A row of staples connects two parts of a hollow tubular organ of the body (for example, two intestines). minutes) is applied to concatenate. The stapler 10 is a remote stapling assembly 12. and the nearest actuator assembly] 4, and the actuating force and force for connecting these assemblies. a longitudinal system of the reservoir that transmits motion from the actuator assembly to the stapling assembly; A shaft assembly 16 is provided.

According to the invention, the shirt I/assembly 16 has a length extending from section A to section B. A flexible portion 13 is attached in the direction. In the particular embodiment shown in FIG. The portion can be bent both above and below the mid-plane of the instrument. below In another embodiment described in , the instrument can bend in only one direction from the intermediate plane. Ru. Maximum warpage from the straight state and bending of the flexible part corresponding to the warpage The radius is determined by the type of device and its intended use, and is typically For a typical instrument, the maximum warp is about 30°, and the corresponding radius of curvature is about 6 Ideally, it should be inches.

The stapling assembly 12, which is best described initially with reference to FIG. Anvil assembly 20 attached to the distal end of anvil support rond 30 and a kiss retaining assembly 40. Rondo 30 is a pair of assemblies 20 and 40. The staple retaining assembly 40 has a long It is installed so that it can freely reciprocate in the horizontal direction. As you can see in Figure 4, the anobyl assembly body 2 (lj, comprising a staple anvil 22 and an annular cutting ring 26; There is. In FIG. 3, the staple retaining assembly 40 consists of two closely spaced concentric rings. Hawthong 4 holding a plurality of surgical U-shaped metal staples 5° arranged in rows 2. The sharp free ends of the legs of each stapler 50 form an anobile assembly 2. It is facing in the far direction towards 0. Additionally, the staple holding assembly 40 is an annular assembly. A weaving cutting knife 52 is built in inside the annular row of staples 50 (similar to this) L. There is. The sharp tissue cutting blade of the knife 52 is directed toward the cutting ring 26 of the anobile assembly 20. It's facing in a far direction. In addition, the stapler holding assembly 40K is a stapler holding assembly 40K. housing for driving needle 50 and knife 52 toward anvil assembly 20; A pusher assembly 44 is mounted for longitudinal movement relative to 40. ing.

Both the annobil assembly 20 and the staple retaining assembly 40 are keyed to the rond 30. so that the anvil assembly 20 is stapled around the longitudinal axis of the device. It cannot rotate relative to the needle retaining assembly 40. This allows the anvil to Therefore, the stapler 50 can be stapled as desired to properly bend the stapler. Keep the staple diagonal of the fishing anvil 22 aligned with the groove or pocket 24. .

Although not necessary to an understanding of the invention, it is important to note the construction of stapling assemblies of the type described above. Additional details can be found in the aforementioned U.S. Patent Nos. 30U, 23B (Conta et al.) seen in

In use, in a typical application where two crotch sections are joined together, the shaft assembly The flexible portion 13 of 16 is shaped to suit the particular patient and surgical procedure being performed. transforms into The staple retaining assembly 40 is then attached to one side as shown in FIG. An anvil assembly 20 is located within the end of the crotch section 18a and within the end of the other crotch section 18b. Position the instrument relative to the entire tissue. Cutting of organ parts i8a and 18b Assemble the residual limbs with hand-attached purse string-like sewing threads 19a and 19b. It is fixed around the rond 30 between the solid bodies 20 and 40. Then the equipment below operates as described to retract the anopyr support rondo 30, thereby the staple assembly 2o towards the staple holding assembly 40. Anopil supporter When the head 30 is fully retracted as shown in FIG. is firmly attached to each other between opposing surfaces of anvil assembly 20 and staple retaining assembly 40. It's pinched.

Once the tissues of the organ parts are clamped together as described above, the instrument can be further fabricated as described below. by moving the annular row of staples 50 into the staple holding assembly 4 as shown in FIG. The stapler is driven from o through the pinched tissue toward the fishing anvil 22. Hoti The kissing anvil 22 bends the end of the staple 50 so that the two organ parts are They are secured to each other by a circular row of staples. In addition, all staples The same actuation of the driving instrument also drives the knife 52 to remove the annular row of staples. Separate the inner waste or excess tissue, thereby separating the connected organ parts. Clean the lumen. At this time, the joining of the organ parts is completed and the instrumentation is completed as described below. can be removed.

The annobil assembly 20 is stapled to remove the device from the stapled tissue. When the needle is again removed from the needle retention assembly 40, the tissue is no longer clamped by the instrument. Next The device is then removed by pulling it out of the organ portion 18a. knife 5 The excess tissue separated by 2 is threaded with sewing threads 19a and 19b. 3o, this tissue is removed along with the instrument.

Actuator assembly 14 allows the instrument operator to activate the stapling assembly 12 as described above. can be caused. Shaft assembly 16 provides the required force and motion to the actuator assembly. from the body 14 to the stapling assembly 12.

For example, as seen in FIGS. 3 and S, the shaft assembly 16 is an outer tube assembly. It has a body of 6o. As discussed in detail below, tube assembly 6o is connected to organ 18a and and 1.8b between the anobyl assembly 20 and the staple holding assembly 40. while transmitting a longitudinal compressive force from the actuating assembly 14 to the staple retaining assembly 4o. It acts on the compression member of the reservoir. By transmitting this compressive force, When the nobile assembly 2o is strongly attracted to the staple holding assembly 40, the tube assembly Body 6o keeps staple holder 40 essentially stationary relative to actuation assembly 4o.

The tube assembly 60 has a straight proximal portion 62 and a flexible intermediate portion 64, straight through the tube assembly 60. and a long distance portion 66. The proximal portion 62 includes the actuator assembly 14. The main body 100 is layered. The distal portion 66 includes a staple retaining assembly 4. 0 housing 42 is installed 11f. There is a segment between parts 62 and 66. A flexible portion 64 is provided which is comprised of an element 600.

These segments) 600 allow the assembly 60 to fully curvature while transmitting compressive forces. It can bend and maintain its curvature. Configuration and operation of segment 600 are discussed below.

As best seen in FIGS. 1 and 2, the actuator body 100 is It is equipped with a yoke 110, and the yaw 110 on the nearer side has an opposing arm extending toward the nearer side. Dollars 120a and 120b are generated by pins 122a and 122b, respectively. I'm totally on point. Handle 120a.

120b denotes compression coil springs 124a and 124b within the yoke 110 (Fig. 2). ) is elastically biased outward. As detailed below, The kissing needle 50 and the knife 52 are gripped together with the handles 120a and 120bi. driven by

To prevent the handles 120a and 120b from being accidentally tightened prematurely. , a safety collar 130 is attached to the actuator body on the proximal side of the pivot pins 122a, 122b. It is rotatably attached to the housing 100. Safety collar 130 is attached to handle 120 a, 12obO has wings 132a and 132bi that protrude outward, respectively. . A safety collar 130 operates between the actuator body 100 and the collar 130. a spring (not shown) in the direction opposite to that indicated by arrow 131 in FIG. It is elastically biased to rotate in the direction. Handle 120a.

Inwardly extending legs 128a are respectively provided on 120b.

128b causes safety collar 130 to rotate further in this direction than shown in FIG. is prevented from doing. In this position, the wings 132a, 132b are attached to the handle 12. 0a.

120b to prevent accidental gripping of these nondles. To prevent. Also, the same tabs 134a and 134b (only tab 134a is shown in the drawing) (visible) projecting outwardly from the safety collar 130. Tabs 134a, 134b are substantially parallel to each of the wings 132a, 132b, while each of the legs 128a , 128b and spaced apart from each of those wings on the same buttside side. Each tag The wings 1.34a, 134b extend further radially outward than the wings 132as 132b. Since the ends of tabs 134a and 134b are /-7$120as120b to stop the rotation of the safety collar 130 in the direction indicated by the arrow 131 by contacting the side surface of the safety collar 130. Ru. Nondol 120a.

1° 20b' from contact with the wings 132a, 132b, press tab 1. 34a or 134b adjacent to or in contact with the handle 120a or 120 b to rotate the safety collar 130 in the direction of the arrow 131.

The end of the tag 134a% 134b is /% the side of the bundle 120as120b When the blades 132a and 132b come into contact with the hand, the ends of the wings 132a and 132b 20b slot 133a.

133b, respectively. The wings 132a, 132b have slots 133a, 13 3b, so both nondles 120a and 120b can be tightened together. Ru.

On the near side of the yoke 110, a cylindrical nut 14° (see Figure 2) attaches to the body. annular flange 142 of nut 140 cooperating with annular channel 112 of nut 100; is rotatably mounted about the longitudinal axis of the instrument. Natsuto Cover 150 is securely attached to nut 140 and includes handle 120a, It extends in the front direction between 12 Ob. The near end of cover 150 is accessible to the operator. Laterally extending wings 152a and 152b are provided to facilitate rotation of the cover 150. We are prepared. Thus, nut 140 and cover 150 collectively represent the wing nut 140 and cover 150. A wing nut called 150 is constructed. Also, the near end of the wing nut 150 is The instrument operator observes the indicator mark 163 on the wing nut 1501'F as described below. Two opposing holes 154a and 154b are provided so that the opening can be carried out.

Inside the hollow outer tube assembly 60 and the actuator body 1oo, there is a hole corresponding to the outer tube assembly 60. A hollow outer tube assembly 70 is provided which is mounted for longitudinal movement.

The tube assembly 70 is a straight tube extending from the inside of the nut 140 to approximately the cross section A. A portion 72 extending from the dowel cross section A to approximately the cross section B and an intermediate portion of the outer pipe structure body 6o. The middle flexible portion 74 is aligned with the staple in the longitudinal direction (from cross section B). and a straight distal portion 76 extending into the retention assembly 40. Discussed below The closer portion 72 is directly connected to the handles 120a, 120bVc so that The distal portion 76 extends into the staple retaining assembly 40 and holds the staple/knife. It is in direct contact with the fugusha assembly 44. In operation, the tube assembly 70... 120a, 120b (and the longitudinal compressive force produced by the operation of movement) from the actuator assembly 14 to the staple/knife in the staple retention assembly 40. It constitutes a compressing member that transmits the transmission to the shutter assembly 44. Therefore, the tube assembly Body 70 provides the force and motion necessary to drive staple 50 and knife 52. is transmitted from actuator assembly 14 to stapling assembly 12 .

In operation, the tube assembly 70 is inserted into the side holes 71a, 7Lb of its proximal portion 72. driven distally by the respective engaged handle protrusions 126a, 126b. Ru.

Thus, the safety collar 130 is rotated to release the nondles 120a and 120bi. When these nondles are squeezed together and tightened to the position shown by the broken line in Figure 4, the inner tube assembly is assembled. 70 moves in a distal direction relative to outer tube assembly 60 and as shown in FIG. The contact between the second portion 76 and the gunonja assembly 44 causes the staple 50 and knife to 52nd party drive. Distal portion 76 restrains longitudinal movement of tube assembly 70. Insert a key (not shown) into the keyway from the housing 42 to the longitudinal keyway of the rod 30. 32 (Fig. 4) having a longitudinal slot 79 (Fig. 4) for extending into the Ru. These keys cooperate with rod 30 to secure the staple to anvil assembly 20. Maintain angular alignment of holding assembly 4o.

Similar to the intermediate section 64 of the outer tube assembly 60, the intermediate section 74 of the inner tube assembly 70 has a plurality of The segments or elements 700 of the pipe assembly 70 is capable of being deformed into a curvature and maintaining its curvature while transmitting a compressive force. Ru. Details of the construction and operation of segments 7oo, and these segments and outer tubes The relationship between the assembly 60 and the segment 600 will be described later.

In the proximal portion 72 of the tube assembly 70, a nut is inserted from the side of the tip of section A. A rod 160C extending through the wing nut 140' to the inside of the wing nut 15° (see Figure 4). The rod 160 is lengthwise relative to the surrounding element. It is provided so that it can freely reciprocate in the direction, and its longitudinal axis is Rotation about the center is prevented. The transverse pin 168 passes through the rod 160 into the tube. It extends into a longitudinal slot 71C%7]d of part 72 of the assembly. B The intermediate portion 164 of the wing nut 160 threadably engages the wing nut 140. When o rotates, the rod 160 moves toward the front depending on the direction of rotation of the wing nut 150. or move in a far direction. The proximal portion 162 of the rod 160 is on the opposite side of the rod. An instruction mark 163 is provided. Bend the staple 50 appropriately with the anobil. When the anvil assembly 2o is close enough to the staple holding assembly 40 to As shown in the figure, the instruction mark 163 is located at the hole 1548% 154b of the wing nut 150. I can see through it.

Linear movement of rod 160 in response to rotation of wing nut 150 causes flexible band 80 Therefore, it is transmitted to the rod 30. Flexible band 80 is a surrounding element within tube assembly 70. It is provided so that it can freely reciprocate in the length direction. Band 80 is typically acceptable Several small diameter plugs are attached to the outer device 3 made of flexible plastic or similar material. It consists of embedded flexible metal cables. This configuration allows the band to High longitudinal flexibility and high tensile strength are obtained. Near the flexible band 80 The other end is connected to the distal end of rod 160 by -7168 and is connected to the distal end of rod 160 by The distal end is connected to the near end of the rod 30 by a pin 82.

The flexible band 80 can be used to transmit small longitudinal compressive forces (e.g. (to separate the staple assembly 20 from the staple retention assembly 40) However, the main function of the flexible band 80 is to hold the stapler in the anobile assembly 20. towards the assembly 40 and then during stapling and cutting these two Longitudinal tension (and associated movement) to keep the tissue pinched by the assembly ) to actuator assembly 14 and stapling assembly 12. There are many things. The force required to pinch the tissue is approximately SO ~ 700 pounds, and The force required to drive the kissing needle is approximately 2oo, I? to drive the band knife The force required to It is clear that during operation it is necessary to transmit more than 300 pounds of tension. That's it. Similarly, while pinching the tissue, the staple retention assembly 40'Q actuator The outer tube assembly 6o, which is kept fixed to the assembly 14, has a compressive force of 30 bonds or more. power to drive the stapler and knife. The inner tube assembly 7o is required to transmit more than 200 pounds of compressive force.

These forces are due to the structure of the segments 600, 700 and the flexibility of these segments. The flexible parts 64, 74 are brought into their straight state by cooperation with the band 8o. transmitted through the flexible portions 64, 74 of the tube assemblies 60, 70 without return. . The above structure and cooperation will be explained below.

First, if we focus on the band 80, this band is curved and transmits tension in the longitudinal direction. When inside, a resultant force occurs, which acts on the band 8o along its length, Try to straighten band 80. The direction of this resultant force is along the length of the band 80. perpendicular to the axis of the band and toward the center of curvature of the band. The magnitude of this combined force is determined by the local curvature of band 80, and bands with different local curvatures They differ in several respects. As a first approximation, band 80 is a thin flexible Kerpul The cable behaves like a catenary, and for this the longitudinal tension T must be determined by the shape of the cable. It is considered to generate a resultant force F that varies as a second derivative of the shape ψ(xl).

The compressed parts U'60.70, in particular their flexible parts 64.74, are and vibrates essentially in the same way as band 80 when transmitting longitudinal compressive force. dance

Further, such shrines 60 and 70 are arranged at right angles to their respective longitudinal axes. with the local curvature of member 6o or 7o (i.e., to a first approximation, Generates a resultant force that changes in magnitude depending on the second derivative of the shape of the material.

However, this compression-generating resultant force is opposite to the tension-generating force. This means that, etc. For new tension and compression forces and for the same local curvature, the tension member or That is, the band 80 and the compression member, i.e., the tube assembly 6o or the tube assembly 70 are equally This means that the opposite resultant force is generated. Therefore, these forces can be reciprocated. The tension and compression members are kept in equilibrium with each other by so that neither member returns to its straight state and both remain longitudinally transmit the force of the direction. As discussed below, segments 600, 700 . band 8 0 and the resultant force transmission members 704a and 7.04b (Fig. 1/Fig. 1) transmit a balanced resultant force. constructed and arranged to achieve this result.

Referring to FIGS. 7 to 1, a cylindrical protrusion 602a-6 Segments 600.7 in contact via 02d, 702a-702df A first embodiment of the shaft assembly 16 using the 00 is shown. Especially the first/ As shown, the general configuration of the flexible portion 13 of the shaft assembly 16 is longitudinally a flexible band 8o whose axis lies in the mid-plane of the shaft assembly; The composite force transmission members 704a are located at the upper and lower sides, respectively.

704b and washer-like segment 7o of the inner tube assembly.

, an elastic outer tube 710, a washer-like segment 600 of the outer tube assembly 6o, and an outer tube 710. and an elastic mantle tube 610 on the other hand.

Considering segments 600 and 700 first, these segments When the solid body 16 is deformed into a curve, it is configured to rotate by rotating each other. has been completed. This rotation is caused by the protrusions 602a to 602d.

Adjacent segments given by 702a-702d (see Figure 1.!) ) 600,700 between the bodies.

The protrusions themselves connect each adjacent segment to form a line of contact between two adjacent segments. contact with the protrusion of the component.

This line contact is shown in FIG. 27, where segment 600n is connected to line 34. It is noted that the segment 600n-H is contacted along the line 600n-H. Similarly, seg Men) 700n touches segment 7QOn++ along the same line, but 20 As discussed below, the contact lines of segment 600 and segment 700 are may be offset in the length direction. As shown in Figure 12, between the segments Line contact is the entire range of rotation of one segment with respect to its adjacent segment. is maintained.

The contact lines 34 together form a geometric surface 36.

The longitudinal axis 88 of the band, more particularly the gundo 80, lies on this surface. (Figure 2).

Therefore, the local curvature of node 80 transmitting longitudinal tension, and the length Compressive force in direction? Local curvature of the curve of the contact point of both transmitting tube assemblies 60.70 are the same. Therefore, as discussed above, for equal tension and compression forces , the shaft assembly produced by the band 80 and the tube assembly 60 or tube assembly 70. The resultant forces perpendicular to the longitudinal axis of the body 16 are equal and opposite.

The contact lines of segment 600 and segment 700 are the same. If they are located on the geometric surface 36, they do not need to match as shown in FIG. child When the contact lines are located on the same geometric surface 36, equal local curvature occurs; This produces equal resultant forces resulting in equal longitudinal forces. Therefore, segment segment 600 and segment 700 need not be longitudinally aligned and may even be equal. It is also not necessary to have large longitudinal dimensions. That is, the segmentation in the tube assembly 60 There may be more segments than segments in tube assembly 70 and vice versa. Same as Table u 59-500949 (7).

To assist in maintaining the band 80 on the surface 36 and the pan, do 80 and tube assembly. To achieve initial alignment with the volume 70, the segment 700 has a recessed portion 720 ( Fig. 9) should be provided. These parts support the band 80 and pinch the tissue. During operation and operation of driving the stapler and nicer, the band and tube assembly 70 and dimensioned for relative movement in the longitudinal direction.

However, the primary element for retaining band 80 to surface 36 is the resultant force transmitting member. 704a and 704b (Figure 1/Figure). These members are the band and inner tube assembly 70. and the inner surface of the segment 700 and the flexible inner tube assembly 70. It contacts these segments with its punt along the entire length of the sexual portion 74. Part 7 04 a.

704b is a flexible, low-friction plastic material such as nylon or Teflon. and are provided with slots) 706 (Fig. 1/Fig. 1) to increase their flexibility. ing.

Due to this low friction property (C), the band 80 and members 704a, 70 4b relative to each other in the length direction to drive the stapler 50 and knife 52. During this period, these members and the shaft assembly 70 are moved relative to each other along their entire length. 1st As shown in Figure 3 and Figure 1, this flexibility allows the shaft assembly 1G to bend. When transformed into a song, the Ki and M materials 704a and 704b are band 80 and segment ) maintain contact with 7'0'0.

During longitudinal force transfer, only one of members 704a, 704b, specifically the band The member 704a or 704b on the concave side of the door 80 acts as a means for transmitting the resultant force. use

Therefore, in FIG. 111, if the assembly 70 is transmitting a force in the longitudinal direction, The band 80 generates a resultant force towards the ground, and the segment 700 generates a resultant force downward. generate force.

The member 704a between the segment 700 and the band 80 balances these combined forces. used as a means of preserving Of course, the shaft assembly 16 is shown in FIG. 704a, the member 704a has a curvature opposite to, that is, a downward curvature. The material 704b acts as a means for transmitting the resultant force.

The main function of the band 80 is to transmit longitudinal tension, and sometimes this band 80 transmits a small longitudinal compressive force to, for example, staple tissue. The anobyl assembly 20 is then moved away from the staple retaining assembly. child In this case, the member 704a or 704b on the convex side of the band 80 (first In figure q, member 704, b) transmits the resultant force produced by band 80. synthesis The force balance is similar to the balance above, but the force magnitudes range over only a few bands. Yes, the mechanical effects of the device are not important. Equilibrium at Gundo 80 in this case The compressive force is so large that it is smaller than the frictional force between the band 80 and the segment 700. It's hard. The compressive force of band 80 required to overcome this friction is Balanced by tension in the mantle 610.710 which prevents separation of the 0.00.700 It will be done. When the anvil moves away from the staple assembly 40, the anvil and tissue Due to the contact of , there is no similar balance of compressive forces. However, as mentioned above, During movement of anobile assembly 20 away from staple holding assembly 40 after kissing The total compressive load on band 80 is only a few pounds; In a slightly compressed state, this state is formed on all sides, so it is easy to bend. There is no such thing.

Surrounding segment 700 is an elastic mantle 710 (Fig. 1/). child The mantle tube is made of lightweight glass material, and the outer surface is coated with Teflon, for example. (i.e., by coating with polytetrafluoroethylene) Has an abrasive outer surface. The mantle tube 710 serves two main functions. First, outside The cannula transmits the resulting compressive force that pinches the tissue from the outer tube assembly 60 to the segment 700. do. This force then passes through segment 700t to force transmitting members 704a, 70. 4b, and finally reaches band 80, where the tension of band 80 causes the Balance is maintained by complementary composite forces that sandwich the tissue.

Shaft assembly caused by longitudinal compression of mantle tube 710I+L by force/combing 16 equal and opposite forces perpendicular to the longitudinal line and during the tissue clamping operation. Through tube assembly 60 and band 80 - each part of the link with transmitted tension to do.

Second, the sheath tube 710 has a low-friction sheath surface that allows the stapler 50 and Shaft assembly 7Mr shaft assembly without undue resistance during driving of cutting knife 52 Move toward the front with respect to the body 60. Also, as discussed above, band 80 moving the staple assembly 20 away from the staple retaining assembly 40; At this time, the mantle tube 710 contributes to restraining the band 80.

Segments 600 of tube assembly 60 are disposed around jacket tube 710. . As discussed above, segment 600 is connected to segment 700 in the instrument. They have qualitatively the same configuration and structure. In particular, segment 600 has adjacent Equipped with cylindrical protrusions n 602a to 602d that make line contact with the protrusions of the segments. and these lines are located on a surface that includes the longitudinal axis of band 80.

Segment 600 receives longitudinal compressive force from actuation assembly 14 during tissue clamping operations. operatively and operatively to transmit a longitudinal compressive force to the stapling assembly 12. The resulting resultant force perpendicular to the longitudinal axis of shaft assembly 16 is 700 and the force transmitting member 704a or 704b to the band 80. communicated.

Surrounding segment 600 is the outer surface of flexible portion 13 of shaft 16. There is a useful elastic jacket tube 610. The mantle tube 610 is made of lightweight plastic. positioning the instrument relative to the tissue formed of the material and to be stapled; It has a smooth outer surface and surface that does not harm the weave. The mantle tube d10 is near it. fixed to the body 100 at one end and to the staple holder 42 at its distal end. It is. The mantle tube 610 is preferably assembled with low initial longitudinal tension. segments 600' are held in contact with each other with a small compressive preload. mantle The tube 610 cooperates with the notch 601 of each segment 600 to form protrusions 6028 to 6028. It has two internal lips 611 that maintain alignment between 602d. Also, reply 6 11 aligns the outer tube 610 with the body 100 and the stapler holder 42. Ru. Along with the cannula 710, the cannula 610 is connected to the flexible portion 1 of the shaft assembly 16. 3 provides a slight stiffness, which is desirable for instrument handling.

First, Figures 1 through 20 relate to segment 600.100 of tube assembly 60.70. 2 shows two alternative embodiments of the invention. In Figures 1.5 to 77, segment 630.730 has a flat posterior surface 632.732 and an immediately anterior segment. sloped away from the flat surface 632 or 732 of 630 or 730 and a front surface having beveled portions 634.734 and 636.736'. Ru. The bevel portions 634 and 636 are the same as the flat layer portions 734 and 736, and the bevel portions 634 and 636 are 738.

This line 738 indicates that when the shaft assembly 16 is deformed into a curve, the segments Serves as a line of contact between adjacent segments when rotating relative to each other.

In FIGS. 1g-20, segments 640, 740 represent the flat rear surface 6. 42.742 and front surfaces, the front surfaces having a flat portion 644.744; away from the flat rear surface 642.742 of the immediately preceding segment 640.740. 646 and 746. flat parts 644 and 7 44 and beveled portions 646 and 746 meet along line 748, which Similar to line 738, spiral line 748 is set when shaft assembly 16 is deformed into a curve. Serves as a line of contact between adjacent segments as the segments rotate relative to each other .

Segments 640, 740 are beveled only above the mid-plane of the device Therefore, this embodiment of the shaft assembly 16 is capable of deforming in the direction shown in FIG. It is only possible to do this.

In both alternative embodiments, as in the first embodiment, the band 80 is connected to the line 7. It is located on the bare plane formed by the group of 38 or 748. Therefore, more than As discussed ((, band 800 local curvature and tube assembly 60 or tube assembly 7 The local curvature of either zero is essentially equal and the length of shaft assembly 16 is Essentially equal and opposite resultant forces perpendicular to the axis force the band 80 and tube assembly 60 or equal longitudinal tension and compression forces in tube assembly 70 or both assemblies. occurs for.

Similarly, as in the first embodiment, the resultant force is the band 80 and segment 7 30 (740) and by members 704a, 704b that contact the inner surface of segment 630 (640), enclosing segment 730 (740). and transfers the force from segment 630 (640) to element 730 (740) and thus Material 704a.

Balance is maintained by a mantle 710 communicating to 704b.

The segments of all three embodiments have common features that make them easy to assemble; The construction is cheap. The selected material is not significantly deformed during operation of the instrument Hard plastic, aluminum, if it can withstand the compressive forces encountered Alternatively, various materials can be used for the segments, such as steel. These forces are 300 pounds while driving the staple 50 and knife 52. .

Moreover, the band 80 and the composite force transmission member 7Q4a.

704b and the remainder of the flexible shaft assembly 16, including the cannula 610, 710. Components are manufactured from lightweight materials that are relatively easy to construct and inexpensive. be able to. In this way, safe instruments can be used after a single use if desired. It can be economically manufactured to be disposable.

In each of the three embodiments shown, segments of the same type are included in both tube assemblies 60.7. 0, but these two tube assemblies use segments of the same shape. I understand that you don't need to do that. Thus, a segment with a cylindrical protrusion 700 to the inner tube assembly 7o, and the double bevel segment 630 to the outer tube assembly 60. and vice versa. Additionally, tension members and compression members Do not generate essentially equal and opposite resultant forces to equalize the longitudinal forces. Other flexible structures and segment shapes may be used.

Considering the overall operation of the device below, the initial position of the anobyl assembly 20 is approximately The substantially fully retracted position shown in FIG. The position is the near end position shown in FIGS. 2 and 3.

In this state, staple until the anobile assembly is adjacent the cut end of organ portion 18a. Clasp assembly 12 is threaded into organ portion 18a. Next, rotate the wing nut 150. Assemble the rod 30 to the stapler with the rod 160 and flexible band 80. Stretch the body by 40 degrees and assemble the purse string-like sewing thread 19ak as shown in Figure 3. an anvil allowing it to be drawn around the rod 30 between the bodies 20 and 40; Insert the assembly 20 into the cut end of the organ portion 18b and thread the thread 19. b'i Pull around the rod 30 as shown in FIG.

When both organ parts are secured to rod 30 as described above, wing nut 150 is Rotate the rod 160 and the flexible band 80 to move the rod 30 toward you. to retreat. During this operation of the device, the flexible band 80Fi typical VC are under relatively low tension due to the force required to pull the organ parts together . As the annobil assembly 20 moves toward the staple holding assembly 40, the rod 1 The direction mark 163 on the near end of the wing nut 150 points towards the near end of the wing nut 150. It moves.

As shown in FIGS. The staple retaining assembly 40 is sufficiently bent so that it can be bent accordingly by Bill. When approached, the indicator mark 163 is located in the slot 154 near the tip of the wing nano) 150. a, 154b. This prepares the instrument to staple tissue. This visually indicates to the surgeon that the procedure has been completed.

The instruction mark 163 looks like a slot 154 a % 154 b circle, and the tissue is When desired to staple, safety collar 130 is attached to tabs 134a, 134b. Rotated by Tehiytorl 2'Oaz 120b'fr: Wing 132 a.

132b has soot. Next, the handles 120a and 120b are attached as shown in FIG. Staple the tissue by squeezing it together to the dashed line shown in .

This causes the tube assembly 7o to move forward, so that the handle protrusion 1 26a, 126b engage slots 71a, 71b in the tube, respectively.

Proximal movement of the tube assembly 70 causes the staple/knife staple assembly 44 to moves forward accordingly. As a result, the stapler 5o and knife 52 are sequentially driven as shown in FIG. The leg of the stapler 5o passes through the tissue and this leg An annular row of staples bends the two organ parts by contact with the stapler. It is fixed by the kissing needle. Knife 52 cuts excess tissue within the annular row of staples. to eliminate the lumen between the connecting organ parts. In this case, the stapling procedure is completely , handle 120a.

To remove the stapled tissue, operate the wing nut 15o again to attach the anobile assembly 20. Release the stapler from the apparatus by separating it from the staple holding assembly 4o. Then the equipment It is removed by pulling out the organ part 13a'i. by knife 52 The cut off excess tissue is fixed to the rod 30 by the sewing thread 19a119b. Since it remains as it is, the intermediation power is lost along with the equipment.

The foregoing description is merely illustrative of the principles of the invention, and is intended to limit the scope and precision of the invention. It is understood that various modifications may be made by those skilled in the art without departing from the scope of the invention. be understood. For example, the shape of the particular actuating assembly shown is not critical. , other actuator structures can be used as desired. To drive tube 70 An actuator whose handle is substantially perpendicular to the longitudinal axis of the instrument is alternatively possible. It is a kind of Such actuators are shown, for example, in the above-mentioned U.S. Pat. 30’l, λ3 Otsu (Conta etc.) (not well known for this type of appliance) be.

For round plane large stop Place PM Torso Volume Rut Tongue

Claims (1)

[Claims] / Place the actuator of the surgical stapler on the stapling assembly located far from the stapler. for coupling and transmitting force along the length between the actuator and the stapling assembly while being able to deform into curvature and transmit force; In a shaft assembly having a longitudinally flexible portion that maintains its curvature, This compression is provided with a longitudinally flexible compression device for transmitting longitudinal compression force. is along the longitudinal axis of the flexible portion of the shaft assembly when the flexible portion is curved. If we generate a resultant force at right angles: A flexible tensile member is provided along the length of the reservoir for transmitting longitudinal tension; When the flexible section is bent, it is aligned with the longitudinal axis of the flexible section of the shaft assembly. produces an angular resultant force, and the resultant force produced by a tensile member has equal tension and compression forces. when the compression device is turned on; and During relative longitudinal movement between the tension member and the compression device, the compression device and the tension member for transmitting forces perpendicular to the longitudinal axis of the flexible portion of the shaft assembly between The force transmission device is biased and Shaft assembly with all features. λ Compression devices are arranged in series along the length of the shaft assembly. Incompressible elements, each element is in longitudinal contact with its adjacent elements, and/or The flexible part is characterized by being able to rotate relative to the adjacent element when it is deformed into a curve. The apparatus according to claim 7. 3. Each of the elements has longitudinal holes, and the tension member passes through these holes; The contact surfaces of adjacent elements are such that when the flexible part is deformed into a curve, the adjacent elements Claim 2, characterized in that it is formed so that it makes line contact when it rotates. The device described in. The q-line contact forms a two-dimensional surface, and the longitudinal axis of the tension member is located on the two-dimensional surface. 4. The device according to claim 3, characterized in that the device is located at: S. The force transmission device connects the tension member and the compressor to the space formed by the hole of the element of the compression device. Claim 3 characterized in that the equipment located between the device and the device is Device. B. Each of the elements has a first and a second contact surface, and the first contact surface contacts the second contact surface of the adjacent element. for contacting two contact surfaces, each first contact surface being essentially flat; , each second contact surface departing from the essentially flat portion and the flat contact surface of the adjacent element. The contact surfaces of adjacent elements have flat portions where the contact surfaces of adjacent elements are in contact with each other. Claim 2 or Claim 2, characterized in that the The device according to item 3. 7. Each of the elements has a first and a second contact surface, the first contact surface being an adjacent non-compressible surface. contacting the second contact surfaces of the sexual elements, each first contact surface being essentially each second contact surface is flat and each second contact surface is separated from the flat surface of the adjacent element. It has two inclined bevel parts, and the contact between adjacent elements is the connection between the two bevel parts. 4. A device according to claim 2 or 3, characterized in that it occurs in combination. g. Each contact surface of each of the elements is provided with a cylindrical protrusion, and the surface of the adjacent element is Claim 1 or 3, characterized in that the contact is made by a cylindrical projection. equipment. The force transmission device includes a longitudinal member, and the friction coefficient between this member and the tension member is equal to the pressure. characterized by being low enough to allow easy manual sliding of the tension member against the compression device; An apparatus according to claim 5. 10. Comprising a longitudinal shaft assembly and two sections for stapling tissue. A stapling assembly and a stapler for controlling the stapling assembly. The actuator assembly is located far from the actuator assembly, and the shaft assembly is connect the stapling assembly to the actuator assembly and connect the actuator assembly to the stapling assembly; the force transmitted between the stapling assembly includes a force for restraining the stapling assembly; surgical binding device.